Wednesday, March 07, 2012

stuck

An evil traffic mastermind has taken over the city. There is no route through town, no backstreet, rat-run, bridleway or smuggler’s path that does not sooner or later crash up against road works. The gas men, the water men, the cable men, the council men, the men who carry out the remedial work after all the other men have gone - the town is infested, over-run, congested, the whole grid in thrall to a sequence of flashing lights, red and white barricades and cones, cones, cones. During the mid part of the day it’s maddening enough, but at rush hour your only hope of reaching the other side of town before sunset is by hot air balloon.

And on top of all that, I was only at this address yesterday.

‘She self-discharged,’ says Control. ‘A CPN made contact back at the address today and says she’s taken another overdose.’
Molly has a history of overdoses and self-harm as chaotic and livid as the scars up her arms.
‘It took us ages to persuade her to come in,’ I tell Frank as he takes a shortcut through a main sewer. ‘And she lives at the bottom of a steep flight of steps. We had a hell of a job keeping her from pitching over backwards the whole time.’
Frank crashes up through a manhole cover, then presses a button I’ve never seen before that sets the axles up on stilts so he can pass above the cars.
‘And then when she was on board, I had to stop her from rolling off the trolley, and lighting cigarettes, and throwing the contents of her bag about.’
‘You’re not selling this job overmuch,’ he says, dropping the cab back down onto the chassis, converting it into a boat, and launching us off the promenade into the sea. ‘I was supposed to be going out tonight.’

We reach the address in good time, considering.

Jo, the CPN, greets us at the door.
‘Molly has taken thirty paracetamol. I’ve told her she needs to go into hospital and be treated, and to try not to walk out.’
‘I’ve met Molly before. I was the crew that took her in yesterday,’ I tell her.
‘Oh. So you’ll know the back history.’
She leads us inside.
Molly is slumped on an armchair as enveloping as a fungal bloom.
‘I’m not going to hospital,’ she sighs. The smoke from her cigarette ripples up to the ceiling. ‘I’ll just walk out again.’
Between the CPN, me and Frank, and Molly’s friend Jack – who was here yesterday, and who glitters on the fringes of the room like a gypsy whose prophecy has come to pass - we try every angle, every point of reasoning and emotional leverage to encourage Molly to leave the chair. But like the chair itself she simply absorbs all our efforts, soaking them up with the smoke and the heat from the fire and the muted images from the TV.
‘I thought you cared for me,’ she breathes, turning her shining eyes on Jo. ‘Why are you doing this?’
‘I do care about you, Molly. That’s why I called the ambulance. You’ve taken a damaging amount of paracetamol and you need to go to the hospital for treatment. I wouldn’t have called the ambulance if I didn’t care.’
‘Come on Molly,’ says Frank. ‘The sooner you get to the hospital, the sooner you can be back again.’
Molly doesn’t respond. She doesn’t even tap off her ash.
‘I just want to leave,’ she breathes.
‘What do you mean?’
‘I just want to leave the hospital.’
‘You’re not in the hospital, Molly. You’re at home.’
‘No. When I’m in the hospital I just want to leave.’
‘I’ll be straight with you Molly. If you don’t go with the ambulance now, I’ll have to go back to the team and make arrangements to bring in the police. That won’t be nice, will it? For you or for anyone. And all that will happen is the police will take you to hospital instead. So whatever happens, you have to go to hospital. At least this way you can go at your own speed, with these guys, and get treated all the quicker, and be back without any trouble. But the other way is a section. Do you understand, Molly? Which has implications. So what do you say? Hmm?’
Molly stares at the smoke rising in an unbroken line from her hand.
‘I just want to leave,’ she says.

I shift my position on the sofa, but I seem to have become part of it, my trousers melded into the covers, my hip bones hooked into the springs. Jack grins at me from across the room. He understands. He knows I’m trapped. But it doesn’t matter. Nothing else is moving, will ever move. We are entering a new age now, an ice age of immobility, and the traffic is a glacier of metal and rubber, inching to a halt on the road above us.

She'd be treated at the hospital for the OD - with a police presence - then transferred to a secure MH facility pending assessment. There are different types of section, keeping you in for different lengths of time. At least it would get her over the current crisis.

Urrrgggghhhh...Dealing with this everyday, What a hopeless thing to face!I think I'd want t start handing out the "How Too" Guide eventually... Said with upmost respect for you work and an unusual laps of empathy.Today I held the hand of a 5 year old student who cried hysterically because of a monstrous tooth ache, no hole says his carrer...Up hill... oxox Hannah

Jacks - It was a difficult one. The CPN was threatening to go down the formal section route, but in reality, because of the paracetamol OD, there wouldn't have been the time to organise the papers. Not sure what we'd have done if she'd have carried on refusing - as it was, between us we managed to wheedle her out of the flat. (Once she's outside, or at the hospital, you can use an emergency 136 - much easier).

It's frustrating - and difficult to rationalise. Molly didn't have to tell the CPN she'd taken a whacking great dose of paracetamol. So you wonder quite what the motivation is - to confess to it, then to dig your heels in. But that's MH. An extraordinarily difficult field. I'm full of admiration for the staff who work there.

Hannah - I think a 'How to' guide would be a great idea. At least some basic first aid education from an early age. I've lost count of the number of children we've been to with a high temp whose parents haven't given Calpol &c.

Basic CPR would be another great thing to learn at school. I know the service is short on funds, but I wonder if more could be done. The Fire Brigade has an amazingly well-organised school visits programme - it would be great to see something similar for the ambulance.

Hannah - I've no doubt in time the ambulances will carry sponsorship from a variety of sources - Stella, Boots the Chemist, Dignitas...

tpals - I suppose in a way they do have that. A person deemed at risk might well be sectioned and detained against their will until the risk has eased. It's just that some problems are so intractable - a tough mixture of social and psych - that it's difficult ever to reach more solid ground.

jean - Admittedly it was an interesting shift. We were trialing a new vehicle - pat pending - the nicest feature being a gigantic mechanical claw that reaches in through the window and gently extracts the patient. The sofa-thing I can only put down to the effects of working shifts. Just say no..